Image by Paul Diaconu from PixabayA new study published in JAMA Ophthalmology highlights major disparities in what commercial insurers pay for common ophthalmology procedures.
To a large degree, the sweeping differences are linked to facility fees, including at facilities such as ambulatory surgery centers (ASCs).
Using recently mandated Transparency in Coverage (TiC) data from January 2025, researchers at Brown University analyzed hundreds of thousands of professional fee price points negotiated between four major insurers – Aetna, Cigna, UnitedHealthcare and Blue Cross Blue Shield – and health care providers working with them.
“Unlike Medicare rates, commercial rates are established through a negotiation process that is not transparent, resulting in rates that are highly variable and opaque,” the researchers wrote.
The cross-sectional study was a unique look at just how much prices diverge for the same services depending on insurer, geography and provider type. And for ASCs, which handle a substantial share of ophthalmology volume – especially cataract surgeries – the findings suggest both opportunities and risks in the fragmented payer landscape.
“Price transparency in ophthalmology is especially relevant given the increasing prevalence of age-related eye conditions and the growing burden of vision-threatening diseases in our aging population,” the researchers continued.
Understanding the study and findings
The researchers focused on 10 common ophthalmology procedures: Laser surgery for post-cataract treatment, eye drug injection, preventative retinal detachment procedure, chalazion removal from eyelid, non-chalazion eyelid lesion removal, iris revision surgery, laser trabeculoplasty surgery, treatment for severe retinopathy, complex cataract removal without ECP and cataract removal without ECP.
Price data were broken out into professional fees (physician payment) and facility fees (ASC or hospital outpatient payment). In total, they examined 684,506 professional fee prices from 15,788 physicians, plus 55,930 facility fee prices across 4,697 facilities.
The team calculated average prices, interquartile ranges and coefficients of variation to assess both the spread and skew of negotiated rates. The prices reflected allowed amounts – what insurers and patients together pay – not billed or list prices.
Across every procedure, facility fees varied more dramatically than professional fees.
For example, in laser trabeculoplasty, the coefficient of variation for facility payments was 3.21, compared with just 0.70 for professional fees. Generally, a higher coefficient variation means prices were much more scattered and less consistent.
“Negotiated facility fees showed substantially greater price variation than professional fees across all ophthalmology procedures, with facility coefficients of variation exceeding professional coefficients by factors of 2 to 4,” the researchers wrote.
There was wide variation from payers, too. In standard cataract surgery, facility fees ranged from $1,521 from Cigna to $4,274 from Aetna.
“Volume-weighted price indices reveal distinct patterns across payers,” the research team noted. “BCBS consistently maintains higher payments, with professional prices 14% above market average and facility prices 13% above average. Aetna shows the most dramatic variation, with professional fees 54% below average but facility fees 45% above average.”
Some possible explanations for pricing differences across payers include market power, selective contracting with providers who accept lower reimbursement rates for greater volume and aggressive negotiating tactics, the researchers speculated.
Geographic variation was even more stark. Median facility payments for standard cataract surgery ranged from under $1,000 in some states to more than $5,000 in others. Professional rates varied as well, but less so, comparatively.
The findings matter for ASCs because they’re frequently selected as the site of service for ophthalmic procedures.
While lower than hospital outpatient departments, ASC facility fees are still an important source of payment, and variation can mean significant differences in margin depending on payer mix and local market dynamics.
Map of Median Rates by State for Standard Cataract Surgery (Facility Rates)
A call for more information
The researchers noted that their work was somewhat limited, especially in terms of not tracking longitudinal trends or recent market changes.
Moving forward, more work is needed to examine the underlying causes of price variation in ophthalmology, they argued. What’s more, the researchers pointed out that existing studies show no relationship between prices and care quality or efficiency.
“If price variation is driven by consolidation or anticompetitive contracting, then regulators should design policies that ensure competitive health care markets,” they wrote.
In the ASC market, the ophthalmology space has been particularly active from an investment and M&A perspective.
In June, Eye Health America partnered with Schneider Eye & Wellness Center in Jacksonville Beach, Florida, expanding the integrated eye care platform’s footprint in Northeast Florida. Eye Health America also acquired Eye Center of Central Georgia earlier in the year.
Around the same time, Unifeye Vision Partners (UVP) partnered with Brooks Eye Associates, a Plano-based ophthalmology practice and surgery center.
Another example of the 2025 ophthalmology activity: SightGrowth Partners expanded its ophthalmology footprint into Massachusetts in the spring with the addition of Papale Eye Center.
